RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2016-00935
BRANCH OF SERVICE:  army	SEPARATION DATE:  20041020

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E2, Trainee, medically separated for “right femoral neck fracture” with a disability rating of 0%. 

CI CONTENTION:  “Please review all conditions.”  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20041007	VARD - 20050610	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Right Femoral Neck Stress Fracture	5009-5003	0%	Residuals Stress Fracture Right Femoral Neck With Screw Fixation	5299-5255	10%	20050412	
COMBINED RATING:  0%	COMBINED RATING OF ALL VA CONDITIONS:  10%	

ANALYSIS SUMMARY:  

Right Femoral Neck Stress Fracture According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI’s right femoral neck stress fracture condition began in June 2004 after road marches.  The 28 June 2004 bone scan showed significant right femoral neck stress fracture.  On 25 June 2004, the CI underwent open reduction and internal fixation of the right hip stress fracture.   

The 9 September 2004 MEB NARSUM examination, 1 month prior to separation, noted complaints of persistent right hip pain.  The CI stated that she could not perform any running, jumping, standing greater than 20 minutes or sitting for prolonged periods.  The CI stated that her legs felt better when she propped them up and sat down for short periods of time.  Physical examination showed range of motion (ROM) of flexion to 120 degrees (normal 125), , abduction to 45 degrees (normal), adduction to 30 degrees (normal 45), internal rotation to 30 degrees (normal 45) and external rotation to 45 degrees.  During the 15 September 2004 MEB examination (recorded on DD Forms 2807-1 and 2808) 1 month prior to separation, the CI continued right hip pain.  Physical examination show mild tenderness at the surgical site with painful right hip ROM.

At the 12 April 2005 VA Compensation and Pension (C&P) evaluation, 6 months after separation, the CI reported pain in the right hip.  The CI admitted to pain in the right lower extremity when going up stairs.  Physical examination showed muscle fatigability, joint pain, stiffness and limited motion of the right lower extremity.  Muscle strength of the right hip flexor was rated as 4/5, however there were no fracture residuals appreciated.  The gait was normal.  The examiner opined that there were mild effects in participation in sports or recreational activities, but no effects on activities of daily living (ADLs).  The ROM showed the right hip had flexion of 0 to 120 degrees with pain exhibited at 90 degrees, extension of 0 to 30 degrees without any pain, abduction of 0 to 30 degrees with pain at 30 degrees, internal rotation of 0 to 20 degrees with pain exhibited at 20 degrees, and external rotation of 0 to 40 degrees with pain exhibited at 40 degrees.  The examiner opined painful movement of the right hip in external rotation beginning at 40 degrees.  Radiographic images of the right hip were obtained on 12 April 2005 that showed 3 bone screws in place “with no sign of displacement or distraction of fracture fragments.” 

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the right femoral neck fracture condition 0%, coded 5009-5003 (Arthritis, degenerative), citing no significant loss of hip motion.  The VA rated the residuals stress fracture right femoral neck with screw fixation condition 10%, coded 5299-5255, (Femur, impairment of) based on the C&P examination 6 months after separation, citing malunion of the femur with slight knee or hip disability.

The MEB and VA examinations showed painful motion for a minimal rating of 10% under medical diagnostic code 5022 (Periostitis).  There was insufficient limitation of motion for a rating under 5251 (thigh limitation of extension), 5252 (thigh limitation of flexion, and 5253 (thigh impairment of), respectively.  The evidence did not support a determination of moderate hip disability for the 20% rating under 5255 (femur, impairment of).  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 10% for the right femoral neck fracture condition, coded 5022.  

BOARD FINDINGS:  In the matter of the right femoral neck stress fracture condition, the panel unanimously recommends a disability rating of 10%, coded 5022 IAW VASRD §4.71a.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends that the CI’s prior determination be modified as follows, effective as of the date of the prior medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Right Femoral Neck Stress Fracture	5022	10%	

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20160919, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record 

AR20170017370, XXXXXXXXXXXXXXXXXXX

XXXXXXXXXXXXXXXXXXX

Dear XXXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found that your disability rating should be modified but not to the degree that would justify changing your separation for disability with severance pay to a permanent retirement with disability.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed) and I accept its recommendation.  This will not result in any change to your separation document or the amount of severance pay.  A copy of this decision will be filed with your Physical Evaluation Board records.  I regret that the facts of the case did not provide you with the outcome you may have desired.
  
	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction. 

	A copy of this decision has also been provided to the Department of Veterans Affairs.

Sincerely,	
Enclosure